Eye Treatment Consultation Form
Thank you for choosing Beau Belles for your lash and brow treatments. Completion of this form is mandatory prior to your appointment so we can ensure there are no known reasons that prevent us from carrying out your chosen treatment, and there is no risk to your health and safety.
Street Address Line 2
Postal / Zip Code
Health History | Please check any of the following that applies to you
Allergy to adhesives band aid or medical tape
Blepharitis (inflamed eyelids)
Dry eye syndrome
Eye disease or injury
Permanent eye-makeup/microblading in last 6 months
Drugs that may cause temporary hair loss or thinning of skin
Major surgery within last 120 days
You have ticked one or more contraindications above - please give further details if relevant
Treatment requested (patch test is required at least 48 hours prior to treatment)
Lash Lift/Brow Lamination
Date of patch test
Please agree to the terms and conditions
I understand that I need to adhere to the after-care instructions to maintain good results following my treatment.
I understand that on rare occasions there are risks associated with having lash and brow treatments. I further understand that in rare circumstances eye or skin irritation and discomfort may occur.
I understand I am responsible for informing Beau Belles of any changes to the information provided above as this may my own health & safety, and/or the result of treatment.
I confirm I have had no adverse reactions (itching, redness, soreness, or other irritation) following patch testing.
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